vit d deficiency
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D deficiency
Presented by :
Asmaa
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Vit D
Vitamin D is a group of fat-soluble vitamins.
Vitamin has several important functionsin the body:
It helps to absorb dietary calcium and phosphorusfrom the intestines.
It suppresses the release of parathyroid hormone, ahormone that causes bone resorption.
Vitamin D may have other benefits, such as
improving muscle and immune function.
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Sources of vit D:
1. skin source
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2. nutritional source:
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Vit D deficiency
Vitamin D deficiency is caused by:
decreased exposure to the sun,
an inability of the body to absorb vitamin D,
or a lack of vitamin D in the diet.
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Risk Factors for vit ddeficiency:
Dark Skin
Intestinal malabsorption
Inflammatory Bowel disease Gastric bypass
No sun exposure
Osteomalacia/Fragility Fractures Renal Disease
Old age
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Symptoms of Vitamin Ddeficiency:
Many people have no symptoms of vitamin Ddeficiency until complications are present.Symptoms may also be mild.
Symptoms of vitamin D deficiency include:
Bone pain ,muscle cramps,
weakness and tingling,
loss of height.
difficulty standing up or climbing stairs
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Complications of vitamin Ddeficiency:
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Complications of vitamin Ddeficiency:
Rickets, Osteomalacia,
and osteoporosis .
tetany
other possible complications include:
hypertension,
depression,
cardiovascular disease,
and an increased risk of cancer
f i d
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management of vit ddeficiency:
a. diagnosis :often missed
signs and symptoms develop slowly or arenonspecific.
normal values in adults :
1. A normal level :25OHD concentration >30 ng/mL
2. Vitamin D insufficiency 25OHDconcentration =20 to 30 ng/mL
3. Vitamin D deficiency 25OHD level < 20
ng/mL
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Diagnosis may be suspectedbased on any of the following:
1.A history
2.Symptoms and signs of rickets, osteomalacia, orneonatal tetany
3.Blood test of 25(OH)D (D2+D3) levels
the best way to diagnose deficiency
4. Characteristic bone changes seen on xray
5.serum levels ofCa,
alkaline phosphatase, PTH
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treatment of vit Ddeficiency:
1.summer day sun
2.artificial UVB radiation
3.human Oral vit D
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available forms of vitamin D supplements are :
ergocalciferol (vitamin D2)
cholecalciferol (vitamin D3).
Vit D3 is better than vit D2:
1. vitamin D3 is the naturally occurring form
2. ergocalciferol is not human, and itsconsumption results in metabolic by-productsnot normally found in humans
3. vit D2 is also two- to four-times less effective
than vit D3
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dose of vit d therapy
depends on:age
body weight
skin colour
patients with malabsorbtion
syndrome.
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Vit d deficiency in theelderly:
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Causes of vit d deficiency inthe elderly:
1. The production of vitamin D from theskin decreases with age.
reduced levels of 7-dehydrocholesterol,
2. Housebound elderly people often do notget adequate exposure to sunlight.
3. Decreased dietary intake, impairedintestinal absorption, and impaired
hydroxylation in the liver and kidneys
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Consequences of vit ddeficiency in the elderly:
1. high bone turnover, bone loss,mineralization defects, and hip andother fractures. Less certain
consequences include myopathy andfalls.
2. osteomalacia:
3. osteoporosis:4. Cancer
5. cardiovascular diseases:
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1. high bone turnover, bone loss,mineralization defects, and hip and
other fractures. Less certainconsequences include myopathyand falls.
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2. osteomalacia:
Osteomalacia is the softening of the bones
due to defective bone mineralization.
Signs and Symptoms:
Bone weakness and pain Muscle weakness
Easy fracturing
Hypocalcaemia
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Biochemical findings
The serum calcium is low
Urinary calcium is low
Serum phosphate is low
Serum alkaline phosphatase is high
Radiological appearances include:Pseudo fractures, also called Loosers
zones.
Protrusio acetabuli, a hip joint disorder
Treatment
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3.osteoporosis: is a disease of bones that leads to
an increased risk of fracture. Inosteoporosis the bone mineraldensity (BMD) is reduced, bone
microarchitecture is disrupted, andthe amount and variety of proteins inbone is altered.
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4. cancer
The effect mechanisms : regulation of the cell cycle,
stimulation of differentiation,
impairment of growth stimuli, inhibition of angiogenesis
and increased apoptosis of malignantcells.
The active vitamin D metabolite 1,25-dihydroxyvitamin D3 (1,25(OH)2D3,Calcitriol) is a major regulator of geneexpression
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Common types of cancerthat vit D can suppress:
1.Colon Cancer
2.Prostate Cancer
3.breast cancer
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. Cardiovascular disease.
Vitamin D receptors have a broadtissue distribution that includes
vascular smooth muscle,endothelium, and cardiomyocytes.
Vitamin D deficiency also alters
hormone levels and immune function,which can increase the risk ofdiabetes, a major contributor tocardiovascular disease,
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Cvs diseases that may becaused by low vit D levels:
Atherosclerosis
Hypertension and MyocardialHypertrophy and infarction
Congestive Heart Failure